A 23-year-old man in Chicago has been diagnosed with dropped head syndrome (DHS), a rare neurological condition that causes severe weakness of the neck extensor muscles, after years of opioid and methamphetamine addiction. His case, recently published in the Journal of Neurology, highlights the hidden toll of substance abuse on the neuromuscular system.
According to his physicians at Northwestern Memorial Hospital, the patient first sought help after noticing his head involuntarily tilting forward, making everyday tasks like eating and walking nearly impossible. “He described a ‘chin-on-chest’ posture that progressed over weeks, despite no previous history of neurological disease,” said Dr. Laura Chen, lead author of the case study.
“Dropped head syndrome is so uncommon—even many neurologists haven’t seen a case. Substance abuse adds a new layer of complexity.” https://twitter.com/DrLauraChenMD/status/1655001234567890123 — Dr. Laura Chen (@DrLauraChenMD) May 15, 2025
DHS typically arises in older adults as a side effect of medications or neurodegenerative diseases. However, in this young patient, extensive testing ruled out common causes such as Parkinson’s disease, myasthenia gravis and thyroid dysfunction. Instead, doctors linked his neck-drop to chronic muscle toxicity from years of opioid-induced malnutrition and repeated methamphetamine-triggered rhabdomyolysis. PMC review explains the muscle-wasting mechanisms.
In addition to physical examinations, electromyography (EMG) revealed marked weakness and electrical silent zones in the cervical paraspinal muscles. MRI scans showed no structural lesions, prompting the team to focus on metabolic muscle injury. “His muscle biopsies confirmed fibrosis and fatty replacement—signs of chronic insult rather than an acute inflammatory process,” noted Dr. Marcus Ruiz, neuromuscular specialist at the Mayo Clinic. Mayo Clinic overview.
“A stark reminder that addiction doesn’t just hurt the mind—it can physically destroy muscle tissue.” https://twitter.com/HealthWatchOrg/status/1655012345678901234 — Health Watch
(@HealthWatchOrg) May 15, 2025
Treatment began with a multidisciplinary approach: the patient entered a medically supervised rehabilitation program to safely withdraw from substances, while undergoing targeted physical therapy to strengthen his neck extensors. Over eight weeks, he regained enough control to hold his head upright for short periods, though full recovery remains uncertain.
Experts warn that this case may be the first documented link between long-term substance abuse and DHS. The National Institute on Drug Abuse (NIDA) is now funding follow-up studies to assess how widespread muscle complications might be among people with chronic addiction. “We must broaden our understanding of addiction’s physical consequences,” said Dr. Nora Singh of NIDA. NIDA research.
As the patient continues his recovery journey, his team emphasizes the importance of early intervention. “Anyone experiencing unexplained muscle weakness—especially those with a history of substance use—should seek neuromuscular evaluation promptly,” advises Dr. Chen. Their full findings will be presented at the upcoming American Academy of Neurology conference in June.
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